Alagappan's clinical medicine for dental students.

499 Pages·2015·99.709 MB·English

by  Priya Verma Gupta

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Third Edition
LJAYPEEJ
Alagappan’s
Clinical Medicine
for
Dental Students
New Features
• As per DC/syllabus
• Concise and comprehensive
• System-based assessment for developing clinical skills
R Alagappan
• Flowcharts and illustrations for understanding the complicated
concepts
• Oral manifestations of medical conditions
• Special boxes, i.e. candle box and stethoscope box carrying
clinically relevant information
Edited by
* Latest definitions and guidelines
Priya Verma Gupta
• Updated epidemiological data
• Sample assessment charts.
Alagappan’s
Clinical Medicine
for
Dental Students
Alagappan’s
Clinical Medicine
for
Dental Students
Third Edition
R Alagappan md ficp
Formerly Director
Professor and Head of the Department
Institute of Internal Medicine
Madras Medical College
Chennai
Edited by
Priya Verma Gupta mds fpfa
Editor-in-Chief (Dental)
Jaypee Brothers Medical Publishers (P) Ltd.
The Health Sciences Publisher
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© 2015, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent
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Alagappan’s Clinical Medicine for Dental Students
Third Edition: 2015
ISBN: 978-93-5152-879-1
Dedicated to my beloved parents
M Meenakshi and VN Ramaswamy
and
my beloved wife
Dr. R. Gomathy
for their
patience, support and inspiration
Preface to the Third Edition
It gives me a grand delight to introduce the third edition of this book. This edition covers DCI syllabus with a fresh
presentation.
Every section starts with a chapter on assessment for better understanding of medicine with in-depth practical
knowledge.
The revised third edition has also been enriched with numerous Figures, Tables and Flowcharts, which will help
in better understanding of complex topics. In addition important questions are added in the end of chapters for the
students to check their knowledge and to prepare for university exams.
The revised third edition is due to the devoted hard work of Dr. M. Ramesh and Dr. B. Karthik, postgraduate students
in internal medicine. I express my sincere gratitude to both of them.
I would like to thank my family members for their support and inspiration in bringing out this edition. This edition is
dedicated to my beloved wife Dr.R.Gomathy, M.B.B.S., D.G.O., D.M.C.H.
I profusely thank Shri Jitender P Vij (CEO), Mr. Ankit Vij (Group President), Mr. Tarun Duneja (Director Publishing),
Dr. Priya Verma Gupta (Editor-in-Chief), Dr. Ankit Sharma (Senior Editor), Mr. Vikas Kumar Singh, Mr. Shekhar Bhatt
(Typesetter) and Mr. Neeraj (Graphic Designer) of M/S Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for their
enthusiasm and constant efforts in bringing out this book.
In spite of my best efforts book is bound to have deficiencies. I will be greatful if the readers kindly send their valuable
suggestion to improve the efficiency of the book.
R Alagappan
Preface to the First Edition
Alagappan’s Clinical Medicine for Dental Students, of handy size, and yet giving adequate information, has long been
a want. The tremendous explosion that has taken place in the field of medicine in understanding the molecular basis,
newer diagnostic methods and investigatory modalities along with ever growing list of newer drugs has increased the
bulk of the textbooks of medicine. The duration allotted to learn internal medicine in dental course is very short. So, it is
highly impossible to learn the clinical methods and text of medicine in the time bound dental course.
Keeping the above facts in mind and with my experience in writing the Manual of Practical Medicine for Medical
Students, I have made an attempt to incorporate both clinical methods and the required text as per the syllabus of Indian
Dental Council and various Indian Universities.
I am deeply indebted to Sri Jitendar P Vij, Chairman and Managing Director of Jaypee Brothers Medical Publishers
(P) Ltd who was instrumental in requesting me to write this manual and also to permit me to take certain portions from
Manual of Practical Medicine.
I have few words to express my gratitude to Prof Dr K Kannan who has provided the computer service and Miss J Daisy
Chitra who helped me in computer printing and also in preparing the entire manual.
I wish to acknowledge the contribution of my associates and colleagues in securing the clinical photographs,
echocardiograms, X-rays, CT films and computer line diagrams for this manual: C Lakshmikanthan, R Alagesan, K
Kannan (Madurai), P Raja Sambandam, P Soundarrajan, D Sivagnanasundaram, Hari Ramesh, M Manivasagam, R
Sethuraman, PM Subramaniam, Rathna Sivakumar and M Palaniappan.
I wish to thank the postgraduate students Dr Renju Kuriakose and Dr VP Atmaram who helped me in correcting the
proof.
I wish to acknowledge the help and encouragement provied by the Director Publishing Mr RK Yadav and the editorial
staff of the Jaypee Brothers Medical Pubslishers for their kind cooperation in bringing out this manual.
I do wish and hope that this manual will be very useful to the Dental Students.
R Alagappan
DCI Syllabus for BDS IIIrd Year
Must Know Desirable to know
Aims of medicine, definitions of signs, symptoms,
diagnosis, differential diagnosis, treatment and prognosis
Infections: Enteric fever, AIDS, herpes simplex, herpes Infectious mononucleosis mumps, measles, rubella,
zoster, syphilis diphtheria malaria
Gastrointestinal tract: Stomatitis, gingival hyperplasia, Diarrhea, dysentery, amoebiasis, malabsorption
dysphagia, acid peptic disease, jaundice, acute and
chronic hepatitis, cirrhosis of liver ascites
Cardiovascular system: Acute rheumatic fever
rheumatic valvular heart disease, hypertension,
ischemic heart disease, infective endocarditis, common
arrhythmias, congenital heart disease, congestive cardiac
failure
Respiratory system: Pneumonia, COPD, Pulmonary TB, Lung Abscess, pleural effusion, pneumothorax,
Bronchial asthma bronchiectasis, lung cancers.
Hematology: Anemias, bleeding & clotting disorders,
leukemias, lymphomas, agranulocytosis, splenomegaly,
oral manifestations of hematologic disorders, generalized
lymphadenopathy
Renal System: Acute nephritis, nephrotic syndrome Renal failure
Nutrition: Avitaminosis Balanced diet, PEM
Central nervous system: Facial palsy, facial pain Meningitis, examination of comatose patient,
including trigeminal neuralgia, epilepsy, headache examination of cranial nerves.
including migraine
Endocrines: Diabetes Mellitus, Acromegaly, Addison’s disease and Cushing’s syndrome.
hypothyroidism, thyrotoxicosis, calcium metabolism,
parathyroids
Critical care: Syncope, cardiac arrest, CPR, shock ARDS
Abbreviations
AAP—American Academy of Periodontology BMI—Body Mass Index
ABC—Airway, Breathing and Circulation BMR—Basal Metabolic Rate
ABPA— Allergic Bronchopulmonary Aspergillosis BMT—Bone Marrow Transplantation
ACE—Angiotensin-converting Enzyme BNP—B-type Natriuretic Peptide
ACLS—Advanced Cardiac Life Support BP—Blood Pressure
ACS—Acute Coronary Syndrome BT—Bleeding Time
ACTH—Adrenocorticotropic Hormone BUN—Blood Urea Nitrogen
ACT—Activated Clotting Time CABG—Coronary Artery Bypass Graft
ADH—Antidiuretic Hormone CAD—Coronary Artery Disease
ADP— Adenosine Diphosphate CAG—Chronic Atrophic Gastritis
AEDs—Anti-epileptic Drugs CAP—Community-acquired pneumonia
AEG—Acute Erosive Gastritis CBC—Complete Blood Count
AF—Atrial Fibrillation CCF—Congestive Cardiac Failure
AFB—Acid-fast Bacillus CCP—Cyclic Citrullinated Peptide
AGE—Acute Gastroenteritis CDC—Centers for Disease Control
AGN—Acute Glomerulonephritis CFU—Colony Forming Units
AHA— American Heart Association CHD—Coronary Heart Disease
AIDS— Acquired Immunodeficiency Syndrome CHF—Congestive Heart Failure
AKI—Acute Kidney Injury CK-MB—Creatine Kinase MB
ALCAPA—Anomalous left coronary artery from the CKD— Chronic Kidney Disease
pulmonary artery CLL—Chronic Lymphocytic Leukaemia
ALL—Acute Lymphoblastic Leukaemia CML—Chronic Myeloid Leukaemia
ALT—Alanine Aminotransferase CMV—Cytomegalovirus
AML—Acute Myeloid Leukaemia CNS—Central Nervous System
ANA—Anti-nuclear Antibodies COPD—Chronic Obstructive Pulmonary Disease
ANUG—Acute Necrotising Ulcerative Gingivitis COX—Cyclo-oxygenase
AP—Anteroposterior CPK-MM—Creatine Phosphokinase MM
aPTT—Activated Partial Thromboplastin Time CPR—Cardiopulmonary Resuscitation
AR—Aortic Regurgitation CRF—Chronic Renal Failure
ARBs—Angiotensin Receptor Blockers CRH—Corticotropin-releasing Hormone
ARC—AIDS-related Complex CRP—C-reactive Protein
ARDS—Acute Respiratory Distress Syndrome CRS—Congenital Rubella Syndrome
ARF—Acute Renal Failure CSF—Cerebrospinal Fluid
ARP—Argyll-Robertson Pupil CSII—Continuous Subcutaneous Insulin Infusion
ART—Anti-retroviral Therapy CT—Computed tomography
AS—Aortic Stenosis CTL—Cytotoxic T Lymphocytes
ASD—Atrial Septal Defect CVA—Cerebrovascular Accident
ATG—Anti-thymocyte Globulin CVD—Cardiovascular Disease
ATN—Acute Tubular Necrosis (ATN) d4T—Stavudine
ATT—Anti-tuberculosis Therapy DBP—Diastotic Blood Pressure
ATZ—Atazanavir ddC—Zalcitabine
AV—Arteriovenous DDI—Didanosine
AVP—Arginine Vasopressin DDT—Dichlorodiphenyltrichloroethane
AZT—Zidovudine DFA-TP—Direct Fluorescent Antibody-T. pallidum
xii Alagappan’s Clinical Medicine for Dental Students
DIC—Disseminated Intravascular Coagulation GOLD—Global Initiative for Chronic Obstructive Lung
DI—Diabetes insipidus Disease
DKA—Diabetic Ketoacidosis GP—Glycoprotein
DLC—Differential Leucocyte Count GPI—General Paralysis of the Insane
DLV—Delavirdine GRD—Gastroesophageal Reflux Disease
DM—Diabetes Mellitus GTT—Glucose Tolerance Test
DNA—Deoxyribonucleic Acid HAART—Highly-active Antiretroviral Therapy
DOTS—Directly-observed Treatment-short-course HAP—Hospital-acquired Pneumonia
Strategy HAV—Hepatitis A Virus
DPaT—Diphtheria, Pertussis and Tetanus Hb—Haemoglobin
DVT—Deep Vein Thrombosis HbE—Haemoglobin E
EBV—Epstein-Barr virus HbF—Foetal Haemoglobin
ECF—Extracellular Fluid HBV—Hepatitis B virus
ECG—Electrocardiogram hCG—Human Chorionic Gonadotropin
ECHO—Echocardiography HCM—Hypertrophic Cardiomyopathy
EDM—Early Diastolic Murmur HCT—Haematocrit
EEG—Electroencephalogram HCV—Hepatitis C Virus
EF—Ejection Fraction HDL—High-density Lipoprotein
EFAs—Essential Fatty Acids HDV—Hepatitis D Virus
EFV—Efavirenz HEV—Hepatitis E Virus
ELISA—Enzyme-linked Immunosorbent Assay HIV—Human Immunodeficiency Virus
EMC—Encephalomyocarditis HLA—Human Leucocyte Antigen
EPO—Erythropoietin HMS—Hyper-reactive Malarial Splenomegaly
ERCP—Endoscopic Retrograde HOCM—Hypertrophic Obstructive Cardiomyopathy
Cholangiopancreatography HPA—Hypothalamo-pituitary-adrenal
ESM—Ejection Systolic Murmur HSCT—Haematopoietic Stem Cell Transplant
ESR—Erythrocyte Sedimentation Rate HSV—Herpes Simplex Virus
FA—Fanconi’s Anaemia HTLV-1—Human T-cell Lymphotropic Virus
FAMA—Fluorescent Antibody to Membrane Antigen HTN—Hypertension
FDCs—Follicular Dendritic Cells IBD—Inflammatory Bowel Disease
FEV1—Forced Expiratory Volume in 1 second ICA—Internal Carotid Artery
FISH—Fluorescent in Situ Hybridization ICD—Implantable Cardioverter Defibrillator
FNAC—Fine Needle Aspiration Cytology ICP—Intracranial Pressure
FSH—Follicle-stimulating Hormone ICT—Intracranial Tension
FTA-ABS—Fluorescent Treponemal Antibody Absorption ICU—Intensive Care Unit
FTC—Emtricitabine IE—Infective Endocarditis
FVC—Forced Vital Capacity IF—Intrinsic Factor
G6PD—Glucose-6-Phosphate Dehydrogenase IFA—Indirect Fluorescent Antibody
GCS—Glasgow Coma Scale IFG—Impaired Fasting Glucose
GDM—Gestational Diabetes Mellitus IFN—Interferon
GERD—Gastroesophageal Reflux Disease IgG—Immunoglobulin G
GFR—Glomerular Filtration Rate IgM—Immunoglobulin M
GGT—Gamma-Glutamyl Transpeptidase IGT—Impaired Glucose Tolerance
GH—Growth Hormone IHA—Indirect Haemagglutination
GI— Gastrointestinal IHD—Ischaemic Heart Disease
GINA—Global Initiative for Asthma IL—Interleukin
GIT—Gastrointestinal Tract ILD—Interstitial lung disease
Gla—Gamma Carboxyglutamic Acid IM—Intramuscular
GN—Glomerulonephritis IMCU—Immediate Medical Care Unit
GnRH—Gonadotropin-releasing Hormone INH—Isoniazid